1206 chap1

• Chain of Infection

  • Infection can be from bacteria, virusess or, fungi.
  • They can cause pus or a fever
  • Infectious agent
  • Reservoir
  • Portal of exit
  • Transmission
  • Portal of entry
  • Host (patient)
• Breaking the Chain of Infection


  1. Clean contaminated objects

  2. Control sources of body fluids and drainage

  3. Perform hand hygiene

  4. Reduce microorganism spread

  5. Maintain skin and mucous membrane integrity

  6. Reduce susceptibility to infection
• Five Moments of Hand Hygiene (WHO, 2019)


  • Before touching a patient
  • Before clean/aseptic procedure
  • After body fluid exposure risk
  • After touching a patient
  • After touching patient surroundings
• Standard Precautions


  • Tier One - for use with ALL PATIENTS
  • Tier Two - Transmission-based precautions for specific types of patients
• Tier One - Standard Precautions


  • Perform hand hygiene
  • Wear gloves
  • Wear PPE
  • Discard contaminated sharp instruments and needles
  • Respiratory hygiene/cough etiquette
• Tier Two - Transmission-based precautions


  • Airborne precautions
  • Droplet precautions
  • Contact precautions
  • Protective environment
• Personal Protective Equipment (PPE)


  • Wear PPE when the nature of interaction with patient indicates that contact with blood or body fluids may occur
  • Remove and discard PPE before leaving the patient's room or cubicle
• Gloves


  Wear gloves when in contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, or potentially contaminated intact skin
• Infections


  • Fections
  • Herpes simplex
  • Scabies
• Protective environment


  • Private room or cohort patients
  • Gloves
  • Gowns
• Wear PPE when the nature of interaction with patient indicates that contact with blood or body fluids may occur
• Before leaving the patient's room or cubicle, remove and discard PPE into the biohazard bag (if heavily soiled with body fluid)
• Gloves


  Wear when in contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, or potentially contaminated intact skin (e.g. of a patient incontinent of stool or urine) could occur
• Removing gloves


  1. Remove after in contact with a patient and/or the surrounding environment using proper technique to prevent hand contamination

  2. Do not wear the same pair of gloves for the care of more than one patient

  3. Change gloves during patient care from a contaminated body site (e.g. perineal area) to a clean body site (e.g. face)
• Gowns


  • Wear to protect skin and prevent soiling or contamination of clothing during procedures and patient-care activities when contact with blood, body fluids, secretions, or excretions is anticipated
  • Wear for direct patient contact if the patient has uncontained secretions or excretions
• Removing gowns


  Remove and perform hand hygiene before leaving patient's environment
• Mouth, Nose, Eye Protection


  • Use PPE to protect the mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions or excretions
  • During aerosol-generating procedures wear one of the following: a face shield that fully covers the front and sides of the face, a mask with attached shield, or a mask and goggles
  • A respirator is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer's risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators must have a mask-to-face seal and must be checked annually to make sure they are providing adequate protection. Using a respirator that has not been fit-tested for your face provides only droplet-based transmission protection, which only reduces the risk of transmission via large particle droplets generated by coughing, sneezing or talking. It will not protect you from airborne transmitted diseases.
• Types of Waste


  • Biohazardous Only (life-threatening) eg blood - yellow
  • Cytotoxic (poisonous cells) eg chemotherapeutic drugs - purple
  • Biohazardous contaminated with cytotoxic eg syringes, needles - purple
  • Radioactive ( rays ) -red
  • Biohazardous and contaminated with radioactive materials - red
  • General waste - black
• Sharps or breakable objects present

  Puncture resistant container required
• Biohazardous Only


  • Gauzes soiled with bodily fluids
• Biohazardous


  • Used syringes and needles contaminated with bodily fluids
  • Partially filled glass vials of hazardous drugs
• Cytotoxic


  • Expired cytotoxic drugs
  • Disposable gloves, bench wipes and gowns used during chemotherapeutic drugs preparation
• Biohazardous contaminated with cytotoxic


  • Used syringes, needles and tubing for administering chemotherapeutic drugs
  • Glass vials with cytotoxic drug residue
• Radioactive


  • Disposable gloves and bench wipes used in the preparation of radioactive materials
• Biohazardous and contaminated with radioactive materials


  • Used syringes and needles for administering radioactive isotopes to patients
• General waste


  • Empty antibiotics and vaccines vials
  • General food, water, pharmaceutics (vitamin tablets, creams and ointments) etc.
• A needle-stick injury occur uncapping/unscrewing needles
• The safe techniques of uncapping new needles and handling used needle are crucial
• If you experienced a needle-stick or sharps injury or were exposed to the blood or other body fluid of a patient during the course of your work

  1. Wash needle-sticks and cuts with soap and water

  2. Flush splashes to the nose, mouth, or skin with water

  3. Irrigate eyes with clean water, saline, or sterile irrigants

  4. Report the incident to your supervisor

  5. Seek medical treatment immediately
• Hand Hygiene (Medical Asepsis)


  • Inspect surface of hands for breaks or cuts in skin or cuticles; cover lesions with dressing before providing care; determine if lesions are too large to cover
  • Inspect hands for visible soiling
  • Inspect condition of nails; ensure nails are short and smooth
• Regular or antimicrobial hand soap


  • Stand at sink, keeping hands and uniform away from sink surface
  • Wet hands and wrists thoroughly under running water. Keep hands and forearms lower than elbows during washing
  • Apply adequate amount of liquid soap or antiseptic cleansing solution to hands
  • Lather hands and apply friction to skin surfaces for 5 strokes on each palm, dorsum, finger interlaces, back of finger, thumb, fingertip and wrist for at least 40 to 60 seconds for the entire procedure
  • Rinse hands and wrists thoroughly
  • Keep hands below elbows
  • Turn off water by using elbow
  • Shake off excess water
  • Dry one hand at a time, wiping from fingers up to wrist using a clean, dry paper towel
  • Discard paper towel properly
• Antiseptic hand rub


  • Dispense appropriate amount of product into palm of one hand
  • Rub hands together, cover all surfaces
  • Rub hands together until alcohol is dry; allow hands to dry completely before applying gloves if needed. The entire procedure should be about 20 to 30 seconds
• Personal Protective Equipment (PPE) Application for Isolation Precautions


  • Assess patient's medical history for possible infections for isolation
  • Review precautions for the specific isolation system, including appropriate barriers to apply
  • Review laboratory test results (e.g. wound culture, acid-fast bacillus smears, changes in WBC count)
  • Consider types of care measures that you will perform while in patient's room (e.g. medication administration or dressing change)
  • Assess patient's understanding of purpose of isolation
• Applying PPE before entering isolation room


  1. Apply cap if necessary

  2. Apply either surgical mask or fitted respirator around mouth and nose (type and fit-testing depend on type of isolation and hospital policy)

  3. If need, apply eyewear or goggles snugly around face and eyes

  4. Apply gown, being sure that it covers all outer garments. Pull sleeves down to wrist. Tie securely at neck and waist

  5. Apply disposable gloves. Bring glove cuffs over edge of gown sleeves

  6. Enter patient's room
• Removing PPE when leaving isolation room


  1. Remove gloves

  2. Perform hand rub

  3. Untie neck strings and then untie back strings of gown. Remove gown from shoulders without touching side of gown. Remove hands from sleeves without touching outside of gown. Fold gown inside out into a bundle and discard in proper container

  4. Remove eyewear, face shield, or goggles. Handle by headband or earpieces. Discard in proper container

  5. Perform hand rub

  6. Remove mask. Handle mask by touching only earpieces or mask strings. Untie bottom mask string and then top string, pull mask away from face, and drop into trash receptacle

  7. Remove cap if applicable

  8. Perform hand hygiene
• Reservoir (site or source of microorganism growth)

  • Control sources of body fluids and drainage.
  • Perform hand hygiene
  • Bathe the patient with soap and water.
  • Change soiled dressings.
  • Dispose of soiled tissues, dressings, or linen in moisture-resistant

  bags.

  • Place syringes, uncapped needles, and intravenous needles in

  designated puncture-proof containers.

  Keep table surfaces clean and dry.
• Portal of exit (means by which microorganisms leave a site)


  Respiratory tract infection

  • Avoid talking, sneezing, or coughing directly over the wound or

  sterile dressing field.

  • Cover nose and mouth when sneezing or coughing.

  • Wear a mask if suffering from respiratory tract

  infection.

  Urine, feces, vomitus, and blood

  • Don on clean gloves when handling blood and body fluids.

  • Wear gowns and protective eyewear if there is a chance of

  splashing fluids.

  • Handle all laboratory specimens as if infectious.
• Transmission (means spread)


  Reduce microorganism spread

  • Perform hand hygiene.

  • Use a personal set of care items for each patient.

  • Avoid dusting bed linen or clothes; dust with a damp cloth.

  • Avoid contact of soiled items with uniform.

  • Discard any item that touches the floor.

  • Follow standard precautions or select transmission-based

  isolation precautions.
• Portal of entry((site through which microorganism enters a host)


  Skin and mucosa

  • Maintain skin and mucous membrane integrity; lubricate skin,

  other frequent hygiene, turning, and positioning.

  • Cover wounds as needed.

  • Clean wound sites thoroughly.

  • Dispose of used needles immediately in puncture-proof

  container.

  Urinary drainage systems

  • Keep all drainage systems closed and intact, maintaining

  downward flow.
• Host (patient's immunity)reduce susceptibility to infection.

  Provide adequate nutrition.

  Ensure adequate rest.

  Promote body defenses against infection.

  Provide immunization.